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Volume 57 (2006)
- Issue 6 Pages 471-
- Issue 5 Pages 407-
- Issue 4 Pages 335-
- Issue 3 Pages 257-
- Issue 2 Pages 57-
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Volume 57, Issue 4
Displaying 1-10 of 10 articles from this issue
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Review
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Hiroyuki Ito2006 Volume 57 Issue 4 Pages 335-344
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSThe effectiveness of training for dysphagia is disputed. Is improvement due to the training or due to natural recovery of the original diseases? I tried to prove the effectiveness of training for dysphagia by physical therapists, but it was impossible to divide the patients into two groups, one training and the other not, because training for dysphagia is prevalent today.
In Japan training for dysphagia was not prevalent since the late 1980s. As the non-training group I therefore chose patients with medullary infarction in domestic reports before 1981, when the training for dysphagia was not prevalent. The courses of the dysphagia were known in 57 patients. The dysphagia of the 2 patients out of 57 was not improved by 168 and 28 days respectively. In 55 patients, 39 men and 16 women, the days from the onset of dysphagia to the improvement was ranged 1 to 150. The average was 30.5 days.
Eight patients with dysphagia due medullary infarction resulted in removal of feeding tubes after training for dysphagia by physical therapists at our hospital from 1984 to 2005. Their days from the onset of dysphagia to the beginning of training ranged from 24 to 569. The average was 187.1. The average days from the beginning the training to the improvement in the 6 patients in whom we could know were 24.2 days. The period from onset of dysphagia to beginning of training was significantly longer than that of the 55 patients in domestic reports. These findings suggested that improvement does not result from natural recovery of the infarction but from training by physical therapists.View full abstractDownload PDF (596K)
Original
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Kaoruko Kajiwara, Satoru Miyamaru, Yoshihiko Kumai, Hidenori Goto, Eij ...2006 Volume 57 Issue 4 Pages 345-350
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSAutologous fat injection into the vocal fold has been reported as a treatment for vocal fold paralysis. However, no report has been seen concerning the effect of lipoinjection for vocal fold atrophy without vocal fold paralysis on phonatory function. We reported pre- and postoperative phonatory functions of 7 patients with vocal fold atrophy treated by lipoinjection. Their subjective symptoms were also evaluated. MPT and MFR showed improvement postoperatively. Five of the 7 patients reported subjective improvement and were satisfied with their postoperative voices. The remaining 2 who responsed that they were dissatisfied with their post-operative voices, showed normal measurements of maximum phonation time and mean airflow rate, preoperatively.View full abstractDownload PDF (640K) -
Yuko Matsumura, Takehiro Karaho, Tetsuya Tanabe, Satoshi Kitahara2006 Volume 57 Issue 4 Pages 351-362
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSThe purpose of this study is to define the influence of bolus volume by examining of the temporal correlation between presenting times of videofluorographic events and swallowing pressure wave components. Simultaneous videofluorography and manometry were performed on 10 healthy adults in swallowing 0-ml (saliva swallow), 5-ml and 10-ml aliquots of liquid barium with a pressure transducer. Its three strain gauge sensors were positioned in the tongue base, hypopharynx, and pharyngoesophageal sphincter (PES). The following events were measured to analyze the presenting time differences from videofluorographic events to related swallowing pressure wave components : A) presenting times of the videofluorographic events : (1)onset of complete tongue base (TB) contact to postpharyngeal wall (PPW), (2) onset of TB detachment from PPW, (3) onset of complete laryngeal closure, (4) onset of laryngeal opening, (5) onset of hyoid superior motion, (6) onset of hyoid anterior motion, (7) hyoid arrival in maximum position, (8) onset of hyoid descent, (9) complete PES closure; and B) swallowing pressure wave components : tongue base T wave onset, T wave peak, T wave end, hypopharyngeal e wave onset, e wave peak, hypopharyngeal c wave peak, c wave end, PES E wave onset, E wave peak, PES wave descent to atmospheric pressure (Pa), PES wave rise to Pa, PES C wave peak. Results : The presenting time differences from ‘T wave end’to ‘onset of TB detachment from PPW’,‘E wave onset’to ‘onset of hyoid superior motion’, and‘E wave peak’to ‘onset of hyoid anterior motion’were extremely short for each bolus volume. The presenting time difference from‘onset of PES opening’to ‘PES wave descend to Pa’ was also extremely short and a minus quantity for 0-ml and 5-ml, but a plus quantity for 10-ml. The presenting time difference from‘PES wave rise to Pa’to ‘complete PES closure’ was shortest in swallowing the 0-ml bolus volume, intermediate for 5-ml, and longest for 10-ml. Conclusion : These findings suggest that the presenting times of both‘T wave end’ and‘onset of TB detachment from PPW’ indicate the appearance time of the identical event in deglutition, and in the same way show ‘E wave onset’ and ‘onset of hyoid superior motion’, and ‘E wave peak’ and ‘onset of hyoid anterior motion’. The temporal correlation between fluorographic PES opening and PES pressure relaxation was thus affected by differences in bolus volume.View full abstractDownload PDF (527K) -
Hirohito Umeno, Hideki Chijiwa, Kikuo Sakamoto, Tadashi Nakashima, Kaz ...2006 Volume 57 Issue 4 Pages 363-370
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSTreatment results were analyzed in 392 hypopharyngeal cancer patients who were radically treated at Kurume University Hospital between 1960 and 2003. In the analysis, they were divided into three chronological groups: the first consisting of 37 patients treated between 1960 and 1970, the second of 122 patients treated between 1971 and 1988, and the third of 233 patients treated between 1989 and 2003. The cause-specific 5-year survival rate for the second group was 38%. In contrast, the survival rate for the third group rose to 67%. The first choice of treatment for early hypopharyngeal cancer in the first and second groups was partial pharyngectomy. However, that of the third group was CO2 laser resection or radiotherapy followed by laser resection. The cause-specific 5-year survival rate with laser surgery was 86%. Over the years, the method of reconstruction after total resection for advanced hypopharyngeal cancer has changed. At present free jejunum reconstructive surgery after total pharyngo-laryngo-esophagectomy is considered to be a safe and most stable method, because it enables resection of the primary lesion with sufficient margin as required. Failure of reconstruction by jejunum graft was detected in only three of 137 patients (2%) who received total pharyngo-laryngo-esophagectomy. In patients who received free jejunum reconstructive surgery, the rate of cause of death tied to primary or metastatic lymph node decreased by resecting the primary lesion with sufficient margin as required, bilateral neck dissection, bilateral Rouviere and paratracheal neck dissection, and post-operative radiation. The findings indicate that treatment results for hypopharyngeal cancer improved dramatically by team practice involving a head and neck surgeon, surgeon, plastic surgeon and radiation oncologist.View full abstractDownload PDF (460K)
Case Report
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Makoto Ogawa, Yoshifumi Yamamoto, Takeshi Kamakura, Hidenori Inohara, ...2006 Volume 57 Issue 4 Pages 371-377
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSWe reported a case in which enlargement of the glottal space was achieved with modified thyroarytenoid myotomy performed to reduce the volume of the vocal cords. The case is a female aged 68 years old suffering from persistent hoarseness for 6 months. At the first visit, she showed symptoms of stridor on aspiration, dyspnea and asthenic hoarseness. Laryngeal fiberscopic examination revealed impaired abductions on aspiration but no abnormalities on phonation or breath holding. After a tracheotomy under local anesthesia, a modified submucosal cordotomy was performed, involving incisions of the upper surface of the vocal cords, resection of the thyroarytenoid muscle, trimming of the mucosal flap, and suturing of the incisions. The incisions healed rapidly without raw-surfaced lesions after the operation. Four months after the operation, laryngoscopic examination showed appropriate closure of the glottis on phonation and a diamond-shaped enlargement of the glottal space on aspiration, with deletion of the stridor and without impairment of phonation deglutition.View full abstractDownload PDF (372K) -
Miwako Kimura, Yoshiki Yokoyama, Takaharu Nito, Masashi Sugasawa, Niro ...2006 Volume 57 Issue 4 Pages 378-384
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSKlippel-Trenaunay Syndrome(KTS)is a group of findings consisting of multiple port wine stains or other blood vessel malformations, excessive growth of bones and soft tissue in the area of increased blood vessels, and varicose veins. A case of airway obstruction caused by pharyngeal and laryngeal hemangiomas is reported. A 13-year-old male was referred to our department for loss of consciousness and dyspnea. A neck and chest CT demonstrated large hemangiomas in the neck that appeared to be spreading to the mediastinum around the trachea with venous stones. Under a diagnosis of airway obstruction caused by enormous laryngeal hemangiomas, steroids were administered. Hemangiomas in cases of KTS have rarely caused airway obstruction in previous reports. With laryngeal hemangiomas, surgical removal or laser surgery is usually favored. In patients for whom an operation poses a high risk, however, steroid administration may prove beneficial.
To our knowledge, this is the first report of airway obstruction associated with hemangiomas with KTS involving the upper airway. Our experience suggests that steroid administration is effective and well tolerated in such patients.View full abstractDownload PDF (446K) -
Keisuke Okubo, Akihiro Shiotani, Koichiro Saito, Kazuhisa Moro, Koji A ...2006 Volume 57 Issue 4 Pages 385-392
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSWe encountered 2 patients with abscess in the deep cervical region complicated with mediastinal abscess requiring surgical drainage, in whom good outcomes were obtained by drainage of abscess in the deep cervical and mediastinal regions via the cervical route. One patient was a 56-year-old male in whom the abscess in the deep cervical region accompanied by dyspnea was treated by incision and drainage, but mediastinal abscess was present. However, a good outcome was obtained by drainage of the mediastinal abscess via the cervical route. The other patient was a 70-year-old female, in whom an abscess cavity between the posterior pharynx space and the mediastinum was observed. Abscess drainage via the cervical route achieved a good outcome. In limited cases of relatively localized cervical and mediastinal abscess with no extensive necrosis or gas bubbles, treatment by thoracotomy preceded by transcervical mediastinal drainage is considered very effective.View full abstractDownload PDF (494K) -
Masahiko Higashikawa, Yumiko Yamamoto, Akihito Mineharu2006 Volume 57 Issue 4 Pages 393-397
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSA 66-year-old female exhibited bulging mucosa of the left piriformis sinus and fixation of the left vocal fold in the median position during a health checkup at a local clinic. Pathological examination of the anterior neck by fine needle aspiration revealed it to be papillary carcinoma. Computed tomography demonstrated that a tumor with severe calcification existed in the left lobe of the thyroid, and the tumor extended into the laryngeal frame through the back of the thyroid cartilage lamina.
We speculated that medialization of the left vocal fold in this case was caused by two factors: invasion to the recurrent nerve causing fixation of the left vocal fold in the median position, and the tumor rotating the left arytenoid cartilage. These two factors made the fixation of the vocal fold in the median position firmer, and the patient consequently had no complaint of hoarseness.View full abstractDownload PDF (377K)
Glossary
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[in Japanese]2006 Volume 57 Issue 4 Pages 398-399
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESS -
[in Japanese]2006 Volume 57 Issue 4 Pages 400-401
Published: 2006
Released on J-STAGE: August 25, 2006
JOURNAL RESTRICTED ACCESSDownload PDF (214K)
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